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Robinson TN, Armstrong SC. Treatment Interventions for Child and Adolescent Obesity: From Evidence to Recommendations to Action. JAMA 2024; 332:201-203. [PMID: 38888897 DOI: 10.1001/jama.2024.11980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Thomas N Robinson
- Stanford Solutions Science Lab, Center for Healthy Weight, Division of General Pediatrics and Stanford Prevention Research Center, Departments of Pediatrics, Medicine, and Epidemiology and Population Health, Stanford University, Palo Alto, California
| | - Sarah C Armstrong
- Division of General Pediatrics and Adolescent Health, Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University, Chapel Hill, North Carolina
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Gance-Cleveland B, Frenn M, Browne N, Greenberg CS, Snethen JA, Hodges EA, Fial AV, Small L, Irving SY. A scoping review of the role of policy in mitigating childhood obesity in underserved populations using the RE-AIM framework. Worldviews Evid Based Nurs 2024. [PMID: 38584314 DOI: 10.1111/wvn.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Childhood obesity is an escalating crisis in the United States. Health policy may impact this epidemic which disproportionally affects underserved populations. AIM The aim was to use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to assess health policy impact on preventing or treating school-aged children (5 > 18 years) with obesity in underserved populations. METHODS A scoping review of 842 articles was conducted. Twenty-four articles met the inclusion criteria and underwent data extraction. RESULTS Twelve studies included subgroup analysis, with four suggesting an impact of policy on at-risk groups. None of the 24 studies fully applied the RE-AIM framework. Policies positively impacted childhood obesity in 12 studies across the sample. LINKING EVIDENCE TO ACTION Our review revealed inconsistent evidence for the effectiveness of policy on childhood obesity, perhaps due to the lack of focus on the social determinants of health. In addition, many studies did not evaluate the outcomes for underserved populations. Therefore, we propose more attention to social determinants in future legislation and evaluation of policy effectiveness on underserved populations. Findings identify an urgent need for the design, implementation, and evaluation of policies specifically directed to address the inequities of racism, social injustices, and social determinants of health that impact childhood obesity in the United States. Future work needs to identify who was reached by the policy, who benefitted from the policy, and how policies were implemented to address obesity-related health disparities. Nurses should advocate for the evaluation of childhood obesity policies, particularly in underserved populations, to determine effectiveness. Nurses, particularly those trained in population and community health and research, should advocate for policy research that considers inequities rather than controls for these variables. Multi-layered interventions can then be tailored to sub-populations and evaluated more effectively.
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Affiliation(s)
- Bonnie Gance-Cleveland
- University of Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | | | | | - Julia A Snethen
- University of Wisconsin-Milwaukee, School of Nursing, Milwaukee, Wisconsin, USA
| | - Eric A Hodges
- The University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Alissa V Fial
- Marquette University, Raynor Memorial Libraries, Milwaukee, Wisconsin, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Sharon Y Irving
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania, USA
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3
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Rainford M, Barbour LA, Birch D, Catalano P, Daniels E, Gremont C, Marshall NE, Wharton K, Thornburg K. Barriers to implementing good nutrition in pregnancy and early childhood: Creating equitable national solutions. Ann N Y Acad Sci 2024; 1534:94-105. [PMID: 38520393 DOI: 10.1111/nyas.15122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Exposure to deleterious stressors in early life, such as poor nutrition, underlies most adult-onset chronic diseases. As rates of chronic disease continue to climb in the United States, a focus on good nutrition before and during pregnancy, lactation, and early childhood provides a potential opportunity to reverse this trend. This report provides an overview of nutrition investigations in pregnancy and early childhood and addresses racial disparities and health outcomes, current national guidelines, and barriers to achieving adequate nutrition in pregnant individuals and children. Current national policies and community interventions to improve nutrition, as well as the current state of nutrition education among healthcare professionals and students, are discussed. Major gaps in knowledge and implementation of nutrition practices during pregnancy and early childhood were identified and action goals were constructed. The action goals are intended to guide the development and implementation of critical nutritional strategies that bridge these gaps. Such goals create a national blueprint for improving the health of mothers and children by promoting long-term developmental outcomes that improve the overall health of the US population.
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Affiliation(s)
- Monique Rainford
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Linda A Barbour
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Darlena Birch
- Public Health Nutrition, National WIC Association, Washington, District of Columbia, USA
| | - Patrick Catalano
- Department of Obstetrics and Gynecology, Tufts University, Boston, Massachusetts, USA
| | - Ella Daniels
- Veggies Early & Often, Partnership for a Healthier America, Washington, District of Columbia, USA
| | - Caron Gremont
- Share Our Strength, Washington, District of Columbia, USA
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Kurt Wharton
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kent Thornburg
- Knight Cardiovascular Institute, Center for Developmental Health, and Moore Institute for Nutrition & Wellness, Oregon Health & Science University, Portland, Oregon, USA
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Bustos B, Lopez M, Dodge KA, Lansford JE, Copeland WE, Odgers CL, Bruckner TA. Family cash transfers in childhood and birthing persons and birth outcomes later in life. SSM Popul Health 2024; 25:101623. [PMID: 38420110 PMCID: PMC10899058 DOI: 10.1016/j.ssmph.2024.101623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
Much literature in the US documents an intergenerational transmission of birthing person and perinatal morbidity in socioeconomically disadvantaged groups. A separate line of work indicates that family cash transfers may improve life chances of low-income families well into adulthood. By exploiting a quasi-random natural experiment of a large family cash transfer among a southeastern American Indian (AI) tribe in rural North Carolina, we examine whether a "perturbation" in socioeconomic status during childhood improves birthing person/perinatal outcomes when they become parents themselves. We acquired birth records on 6805 AI and non-AI infants born from 1995 to 2018. Regression methods to examine effect modification tested whether the birthing person's American Indian (AI) status and exposure to the family cash transfer during their childhood years corresponds with improvements in birthing person and perinatal outcomes. Findings show an increase in age at childbearing (coef: 0.15 years, 95% confidence interval [CI]: 0.05, 0.25) and a decrease in pre-pregnancy body mass index (BMI; coef: -0.42, 95% CI: -0.76, -0.09) with increased duration of cash transfer exposure during childhood. The odds of large-for-gestational age at delivery, as well as mean infant birthweight, is also reduced among AI births whose birthing person had relatively longer duration of exposure to the cash transfer. We, however, observe no relation with other birthing person/perinatal outcomes (e.g., tobacco use during pregnancy, preterm birth). In this rural AI population, cash transfers in one generation correspond with improved birthing person and infant health in the next generation.
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Affiliation(s)
- Brenda Bustos
- Program in Public Health, University of California, Irvine, 856 Health Sciences Quad Irvine, CA, 92697, USA
| | - Marcela Lopez
- Department of Epidemiology and Biostatistics, University of California, Irvine, 856 Health Sciences Quad Irvine, CA, 92697, USA
| | - Kenneth A. Dodge
- Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA
| | - Jennifer E. Lansford
- Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA
| | - William E. Copeland
- Department of Psychiatry, University of Vermont, 1 South Prospect, Burlington, VT, 05405, USA
| | - Candice L. Odgers
- School of Social Ecology, University of California, Irvine, 4326 Social & Behavioral Sciences Gateway, Irvine, CA, 92697, USA
| | - Tim A. Bruckner
- Program in Public Health, University of California, Irvine, 856 Health Sciences Quad Irvine, CA, 92697, USA
- Center for Population, Inequality, and Policy, University of California, Irvine, School of Social Sciences, Irvine, CA, 92697, USA
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5
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Dong L, D'Amico EJ, Dickerson DL, Brown RA, Palimaru AI, Johnson CL, Troxel WM. Bidirectional Associations Between Daily Sleep and Wake Behaviors in Urban American Indian/Alaska Native Youth. J Adolesc Health 2024; 74:350-357. [PMID: 37815766 PMCID: PMC10841395 DOI: 10.1016/j.jadohealth.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE This is the first study to examine daily, bidirectional associations between sleep and wake behaviors/mood in urban American Indian/Alaska Native (AI/AN) adolescents. METHODS Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep was measured with actigraphy (total sleep time [TST] and sleep efficiency) and daily diary (bedtime, wakeup time, and sleep quality) over seven consecutive days. Wake behaviors (caffeine consumption, physical activity, participation in cultural activities, and electronic use after 8p.m.) and mood upon awakening (higher rating indicates greater happiness) were measured via daily diary for seven consecutive days. Multilevel models examined the degree to which nightly sleep predicted next day's wake behaviors and, conversely, wake behaviors and mood predicted nightly sleep, controlling for age, gender, and weekday/weekend. RESULTS Earlier bedtime and wakeup times predicted greater participation in physical activity the following day. Later bedtime and wakeup time, worse sleep quality, and shorter TST predicted greater electronic use the following night. Earlier bedtime and wakeup time and better sleep quality predicted higher mood ratings. Conversely, greater caffeine consumption during the day predicted both later bedtime and wakeup time. Participation in cultural activities is predicted later bedtime. More nighttime electronic use predicted both later bedtime and wakeup time, poorer sleep quality, and worse TST and sleep efficiency. Higher mood ratings in the morning predicted earlier bedtime and later wakeup time. DISCUSSION Findings highlight dynamic associations between sleep and wake behaviors and mood in AI/AN adolescents and may elucidate novel pathways for intervention and future research.
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Affiliation(s)
- Lu Dong
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California.
| | - Elizabeth J D'Amico
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Ryan A Brown
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California
| | - Alina I Palimaru
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California
| | | | - Wendy M Troxel
- Department of Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania
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Huang X, He Y, Xu H, Shen Y, Pan X, Wu J, Chen K. Association between sociodemographic status and the T2DM-related risks in China: implication for reducing T2DM disease burden. Front Public Health 2024; 11:1297203. [PMID: 38259760 PMCID: PMC10801005 DOI: 10.3389/fpubh.2023.1297203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
Objective Analyzing the association between sociodemographic status and the type 2 diabetes mellitus (T2DM)-related risks in China to reduce the disease burden of T2DM. Methods We downloaded data from the Global Burden of Disease Study 2019 to estimate the disease burden of T2DM in China. Secondary analyses were performed by year, age, gender, summary exposure value (SEV), and sociodemographic index (SDI). Results In China, it is estimated that 3.74 (3.44-4.10) million incidence, 90.0 (82.3-98.5) million prevalence, 168.4 (143.2-194.0) thousand deaths, and 9.6 (7.6-11.9) million DALYs occurred in 2019, showing an increase of 96.8, 156.7, 162.8, and 145.4% compared to 1990. An inverse U-shaped curve was observed for the correlations between T2DM-related burden and SDI. A heavier burden was found in males. The top four risk factors were high body mass index (HBMI), dietary risks, air pollution and tobacco. HBMI, as the key risk, accounted for half of the disease burden of T2DM in China. Lower degree of SEV and higher level of attributable T2DM-related burden could be found in main risks, meaning their critical role of them in the development and progression of T2DM. An inverse U-shaped curve could be found in the association between age-standardized incidence, mortality, DALYs rate, and SDI. Conclusion The disease burden of T2DM has rapidly increased in China. Gender disparities, different age distributions and inconsistent socioeconomic levels all played an important role in it. The key risk was HBMI. With the improvement of socioeconomic level, the main risk factors for T2DM have changed from environmental factors to lifestyle factors. Targeted control and preventative strategies to address adjustable risk factors could put an end to this soaring burden.
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Affiliation(s)
- Xin Huang
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
| | - Yinhui He
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
| | - Haiyan Xu
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
| | - Yuyan Shen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of ZheJiang University School of Medicine, Zhejiang, China
| | - Xiaowen Pan
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of ZheJiang University School of Medicine, Zhejiang, China
| | - Junyun Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of ZheJiang University School of Medicine, Zhejiang, China
| | - Kai Chen
- Department of Endocrinology and Metabolism, Lishui Municipal Central Hospital, Lishui, China
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McKinley CE. "Take care of your families, take care of one another": Indigenist families and foodways. FAMILY RELATIONS 2023; 72:2371-2389. [PMID: 38213776 PMCID: PMC10782928 DOI: 10.1111/fare.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 01/21/2023] [Indexed: 01/13/2024]
Abstract
Objective The purpose of this research was to examine how families and foodways have evolved over time and how they may present promising promotive factors for resilience, health, and wellness. Background Because food is central to family, social relationships, and healthy living, Indigenist foodways may promote family resilience and offset inequities. Method Pragmatic horizon analysis of data drawn from 31 critical ethnographic interviews on food and family in the Southeast and Northwest, including both urban and rural reservation tribal contexts, resulted in emergent themes related to food and families. Results Themes included (a) foodways fostering family connectedness: "The fresh vegetable is how I remember my grandpa"; (b) tight-knit extended families and communities: "The community where I grew up … everybody knew each other, so everybody … pitched in"; (c) family and community celebrations nurturing cohesion: "The family I have, I can always count on. I can trust each one of them"; and (d) families fostering healing: "Sit down and talk to somebody … that you can trust." Conclusion Participants explained how foodways promoted family resilience by bringing families and communities together. Indigenist foodways fostered continuity and healing through food preparation and processing and through feasts and gatherings. Implications Foodways were described as fundamental to family resilience and community connectedness. Subsistence fostered exercise, eating locally sourced foods, and family resilience. Interventions are needed to promote Indigenist foodway sovereignty while first understanding how culture, history, and food inform wellness and community well-being.
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Hill CM, Paschall MJ, Koller KR, Day GM, Lee FR, O’Brien DM, King DK, Palmer L, Thomas TK, Bersamin A. Obesity Prevalence and Dietary Factors Among Preschool-Aged Head Start Children in Remote Alaska Native Communities: Baseline Data from the " Got Neqpiaq?" Study. Child Obes 2023; 19:498-506. [PMID: 36473164 PMCID: PMC10541932 DOI: 10.1089/chi.2022.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: American Indian and Alaska Native preschool-aged children experience a high prevalence of obesity, yet are under-represented in obesity prevention research. This study examined obesity prevalence and dietary risk factors among Alaska Native preschool-aged children in southwest Alaska. Methods: The study used baseline data from "Got Neqpiaq?" a culturally centered multilevel intervention focused on Yup'ik Alaska Native children, aged 3-5 years, enrolled in Head Start in 12 communities in southwest Alaska (n = 155). The primary outcomes were BMI percentile, overweight, and obesity. Dietary factors of interest were measured using biomarkers: traditional food intake (nitrogen stable isotope ratio biomarker), ultraprocessed food intake (carbon stable isotope ratio biomarker), and vegetable and fruit intake (skin carotenoid status biomarker measured by the Veggie Meter). Cardiometabolic markers (glycated hemoglobin [HbA1c] and blood cholesterol) were also measured. Results: Among the Yup'ik preschool-aged children in the study, the median BMI percentile was 91, and the prevalence of overweight or obesity was 70%. The traditional food intake biomarker was negatively associated with BMI, whereas the ultraprocessed foods and vegetable and fruit biomarkers were not associated with BMI. HbA1c and blood cholesterol were within healthy levels. Conclusions: The burden of overweight and obesity is high among Yup'ik preschool-aged children. Traditional food intake is inversely associated with BMI, which underscores the need for culturally grounded interventions that emphasize traditional values and knowledge to support the traditional food systems in Alaska Native communities in southwest Alaska. Registered with ClinicalTrials.gov #NCT03601299.
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Affiliation(s)
- Courtney M. Hill
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Mallie J. Paschall
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Kathryn R. Koller
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Gretchen M. Day
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Flora R. Lee
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Diane M. O’Brien
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Diane K. King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, USA
| | - Lea Palmer
- Head Start Program, Rural Alaska Community Action Program, Inc., Anchorage, AK, USA
| | - Timothy K. Thomas
- Research Services, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Andrea Bersamin
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
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Rhee KE, Strong D. Should We "Wait and See"?: Change in Weight Status Among US Adolescents in the Population Assessment of Tobacco and Health Study. Child Obes 2023; 19:373-381. [PMID: 35960810 DOI: 10.1089/chi.2022.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Many parents and providers adopt a "wait and see" approach to obesity (OB) management. The goal of this study was to determine the likelihood that youth with overweight (OW) or OB would become normal weight over time. Methods: Data from the nationally representative Population Assessment of Tobacco and Health Study were used to examine the proportion of teens (aged 12-17 years) with OW/OB who tracked into a lower weight category over four waves of data collection (2013-2018). Analysis was restricted to those who completed all four waves of assessments (n = 10,086). Repeated-measures logistic regression models were used to describe the odds of having a BMI within the normal weight range at Waves 2-4, given an OW or obese weight status in the previous wave. Results: At Wave 1, 65% of the sample was normal weight, 18% had OW, and 17% had OB. By Wave 4, 24% had OW and 20% had OB. The adjusted odds of reporting a normal weight relative to OW/OB decreased by 13% each year. In Wave 4, only 2% [standard error (SE) 0.4%] of boys and 2% (SE 0.3%) of girls transitioned from OB to normal weight. For youth with OB in Wave 1, the probability of being in the normal weight category in Wave 2 was 0.04 (95% confidence interval 0.035-0.052), and decreased thereafter. Conclusion: Very few teens were able to return to normal weight once they developed OW/OB. Adopting a "wait and see" approach to OB management may be detrimental to a child's health.
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Affiliation(s)
- Kyung E Rhee
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
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Vazquez L, Vazquez Arreola E, Hanson RL, Sinha M. Glycemic Measures in Childhood as Predictors of Future Diabetes-Related Microvascular Complications in an Indigenous American Population. Diabetes Care 2023; 46:1659-1667. [PMID: 37433116 PMCID: PMC10465819 DOI: 10.2337/dc23-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/07/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To examine the role of glycemic measures performed during childhood in predicting future diabetes-related nephropathy and retinopathy in a high-risk indigenous American cohort. RESEARCH DESIGN AND METHODS We studied associations between glycated hemoglobin (HbA1c) and 2-h plasma glucose (PG), measured during childhood (age 5 to <20 years) in a longitudinal observational study of diabetes and its complications (1965-2007), and future albuminuria (albumin creatinine ratio [ACR] ≥30 mg/g), severe albuminuria (ACR ≥300 mg/g), and retinopathy (at least one microaneurysm or hemorrhage or proliferative retinopathy on direct ophthalmoscopy). Areas under the receiver operating characteristic curve (AUCs) for childhood glycemic measures when predicting nephropathy and retinopathy were compared. RESULTS Higher baseline levels of HbA1c and 2-h PG significantly increased the risk of future severe albuminuria (HbA1c: hazard ratio [HR] 1.45 per %; 95% CI 1.02-2.05 and 2-h PG: HR 1.21 per mmol/L; 95% CI 1.16-1.27). When categorized by baseline HbA1c, children with prediabetes had a higher incidence of albuminuria (29.7 cases per 1,000 person-years [PY]), severe albuminuria (3.8 cases per 1,000 PY), and retinopathy (7.1 cases per 1,000 PY) than children with normal HbA1c levels (23.8, 2.4, and 1.7 cases per 1,000 PY, respectively); children with diabetes at baseline had the highest incidence of the three complications. No significant differences were observed between AUCs for models with HbA1c, 2-h PG, and fasting PG when predicting albuminuria, severe albuminuria, or retinopathy. CONCLUSIONS In this study, higher glycemia levels ascertained by HbA1c and 2-h PG during childhood were associated with future microvascular complications; this demonstrates the potential utility of screening tests performed in high-risk children in predicting long-term health outcomes.
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Affiliation(s)
- Laura Vazquez
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Elsa Vazquez Arreola
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Robert L. Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
| | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ
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Konuthula D, Tan MM, Burnet DL. Challenges and Opportunities in Diagnosis and Management of Cardiometabolic Risk in Adolescents. Curr Diab Rep 2023; 23:185-193. [PMID: 37273161 PMCID: PMC10240116 DOI: 10.1007/s11892-023-01513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE OF REVIEW This review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population. RECENT FINDINGS There are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism. The existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.
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Affiliation(s)
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Deborah L Burnet
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Department of Pediatrics, University of Chicago, Chicago, IL, USA
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Seamon E, Megheib M, Williams CJ, Murphy CF, Brown HF. Estimating County Level Health Indicators Using Spatial Microsimulation. POPULATION, SPACE AND PLACE 2023; 29:e2647. [PMID: 37822803 PMCID: PMC10564386 DOI: 10.1002/psp.2647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 01/19/2023] [Indexed: 10/13/2023]
Abstract
Given the importance of understanding health outcomes at fine spatial scales, iterative proportional fitting (IPF), a form of small area estimation, was applied to a fixed number of health-related variables (obesity, overweight, diabetes) taken from regionalized 2019 survey responses (n = 5474) from the Idaho Behavioral Risk Factor Surveillance System (BRFSS). Using associated county-level American Community Survey (ACS) census data, a set of constraints, which included age categorization, race, sex, and education level, were used to create county-level weighting matrices for each variable, for each of the seven (7) Idaho public health districts. Using an optimized modeling construction technique, we identified significant constraints and grouping splits for each variable/region, resulting in estimates that were internally and externally validated. Externally validated model results for the most populated counties showed correlations ranging from .79 to .85, with p values all below .05. Estimates indicated higher levels of obesity and overweight individuals for midsouth and southwestern Idaho counties, with a cluster of higher diabetes estimates in the center of the state (Gooding, Lincoln, Minidoka, and Jerome counties). Alternative external sources for health outcomes aligned extremely well with our estimates, with wider confidence intervals in more rural counties with sparse populations.
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Affiliation(s)
- Erich Seamon
- Institute for Modeling, Collaboration, and Innovation (IMCI), University of Idaho, Moscow, Idaho, United States
| | - Mohamed Megheib
- Institute for Modeling, Collaboration, and Innovation (IMCI), University of Idaho, Moscow, Idaho, United States
| | - Christopher J. Williams
- Department of Mathematics and Statistical Sciences, University of Idaho, Moscow, Idaho, United States
| | - Christopher F. Murphy
- Department of Health and Welfare (IDHW), State of Idaho, Boise, Idaho, United States
| | - Helen F. Brown
- Department of Movement Sciences, University of Idaho, Moscow, Idaho, United States
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13
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Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children. Child Obes 2023; 19:341-352. [PMID: 36170116 PMCID: PMC10316527 DOI: 10.1089/chi.2022.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.
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Affiliation(s)
| | - Margaret M. Reid
- Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Jenny J. Chang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Y. Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Cheryl M. Conway
- Charles George Veterans Medical Center, Veterans Health Administration, Washington, DC, USA
| | - Turner R. Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | | | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Angela G. Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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14
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Satterfield D, DeBruyn L, Lofton T, Francis CD, Zoumenou V, DeCora L, Wesner C. "Make Stories That Will Always Be There": Eagle Books' Appeal, Sustainability, and Contributions to Public Health, 2006-2022. Prev Chronic Dis 2023; 20:E26. [PMID: 37055154 PMCID: PMC10109502 DOI: 10.5888/pcd20.220315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
PURPOSE AND OBJECTIVES We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them? INTERVENTION APPROACH Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples. EVALUATION METHODS From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books' sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books' program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings. RESULTS Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books' versatility, flexibility of use, and availability online and in print. IMPLICATIONS FOR PUBLIC HEALTH Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science - through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers - can positively influence community health.
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Affiliation(s)
- Dawn Satterfield
- Native Diabetes Wellness Program, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA 30341
| | - Lemyra DeBruyn
- Native Diabetes Wellness Program, Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Virginie Zoumenou
- University of Maryland Eastern Shore Extension, Princess Anne, Maryland
| | | | - Chelsea Wesner
- Center for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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15
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Johnson-Jennings MD, Reid M, Jiang L, Huyser KR, Brega AG, Steine JF, Manson SM, Chang J, Fyfe-Johnson AL, Hiratsuka V, Conway C, O'Connell J. American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use. Int J Obes (Lond) 2023; 47:297-305. [PMID: 36750690 PMCID: PMC10121828 DOI: 10.1038/s41366-022-01236-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12-19 years in association with social determinants of health (SDOH), and mental health and substance use disorders. METHODS Guided by the World Health Organization's Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12-19 years. We described obesity prevalence in relationship to SDOH and adolescents' mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics. RESULTS We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p < 0.01), residing in a county with lower education attainment (OR = 1.17, p < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p < 0.001). CONCLUSIONS Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.
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Affiliation(s)
| | - Margaret Reid
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, CO, USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R Huyser
- Department of Sociology, The University of British Columbia, Vancouver, BC, Canada
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John F Steine
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenny Chang
- Department of Epidemiology and Biostatistics, University of California, Irvine, Irvine, CA, USA
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, Seattle, WA, USA
| | | | - Cheryl Conway
- Charles George Veterans Medical Center, Ashville, NC, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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16
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Patel D, Sisson SB, Sleet K, Rickman R, Love C, Taniguchi T, Sisk M, Jernigan VBB. Changes in Meal and Menu Quality at Early Care and Education Programs after Training with Food Service Staff: the FRESH Study. Curr Dev Nutr 2023; 7:100040. [PMID: 37181935 PMCID: PMC10111590 DOI: 10.1016/j.cdnut.2023.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 02/22/2023] Open
Abstract
Background Prevalence of obesity in Native American (NA) children is disproportionately high, indicating a higher risk of health disparities. Many children attend early care and education (ECE) programs, presenting an opportune environment to improve meal and menu quality as the intake of healthy foods is associated with lowered risk of childhood obesity. Objectives We aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs. Methods Food service staff from 9 participating ECE programs attended a 3-h training focused on Child and Adult Care Food Program (CACFP) best practices, and received a tailored, best-practice menu, and healthy recipes. Meals and menus prepared across 1 wk were examined per CACFP serving size assumptions at baseline, 4 mos, 6 mos, and 12 mos for all 9 programs. Healthy Eating Index (HEI), CACFP requirements and best practices achievement, and food substitutions quality (classified into superior, equivalent, and inferior based on the nutritional quality) were calculated. A repeated measures ANOVA model was used to determine the differences across time points. Results The total meal HEI score increased significantly from baseline to 4 mos (71.1 ± 2.1; 78.6 ± 5.0; P = 0.004), but did not differ from baseline to 12 mos. Menu CACFP requirements and best practices achievement did not differ across time points, although achievement with CACFP requirements was already high at baseline. Superior nutrition quality substitutions declined from baseline to 6 mos (32.4 ± 8.9; 19.5 ± 10.9; P = 0.007); however, it did not differ from baseline to 12 mos. Equivalent and inferior quality substitutions did not differ across time points. Conclusions Implementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed for improving both meals and menus.This trial was registered ClinicalTrials.gov as NCT03251950 (https://clinicaltrials.gov/ct2/show/NCT03251950?cond=food+resource+equity&draw=2&rank=1).
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Affiliation(s)
- Divya Patel
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan B. Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kaysha Sleet
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- University Medical Center, Lubbock, TX, USA
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Nutritional Sciences, College of Natural Sciences, University of Texas at Austin, Austin, TX, USA
| | - Charlotte Love
- School of Health Care Administration, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK, USA
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17
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Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, Avila Edwards KC, Eneli I, Hamre R, Joseph MM, Lunsford D, Mendonca E, Michalsky MP, Mirza N, Ochoa ER, Sharifi M, Staiano AE, Weedn AE, Flinn SK, Lindros J, Okechukwu K. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics 2023; 151:e2022060640. [PMID: 36622115 DOI: 10.1542/peds.2022-060640] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/10/2023] Open
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18
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Redmond LC, Wensel CR, Estradé M, Fleischhacker SE, Poirer L, Jock BW, Gittelsohn J. Dietary outcomes of a multilevel, multicomponent, cluster randomized obesity intervention in six Native American communities in the upper Midwest and Southwest United States. Curr Dev Nutr 2023. [DOI: 10.1016/j.cdnut.2023.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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19
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So M. Severed Medicines. Clin Pediatr (Phila) 2022:99228221144849. [PMID: 36515526 DOI: 10.1177/00099228221144849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Marvin So
- University of Minnesota Medical School, Minneapolis, MN, USA
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20
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Abstract
While most children with coronavirus 2019 (COVID-19) experience mild illness, some are vulnerable to severe disease and develop long-term complications. Children with disabilities, those from lower-income homes, and those from racial and ethnic minority groups are more likely to be hospitalized and to have poor outcomes following an infection. For many of these same children, a wide range of social, economic, and environmental disadvantages have made it more difficult for them to access COVID-19 vaccines. Ensuring vaccine equity in children and decreasing health disparities promotes the common good and serves society as a whole. In this article, we discuss how the pandemic has exposed long-standing injustices in historically marginalized groups and provide a summary of the research describing the disparities associated with COVID-19 infection, severity, and vaccine uptake. Last, we outline several strategies for addressing some of the issues that can give rise to vaccine inequity in the pediatric population.
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Affiliation(s)
- Carlos R Oliveira
- Corresponding Author: Carlos R. Oliveira, M.D., Ph.D., 15 York Street, PO Box 208064, New Haven, CT 06520-8064, USA. E-mail:
| | - Kristen A Feemster
- Vaccine Education Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erlinda R Ulloa
- Department of Pediatrics, University of California Irvine School of Medicine, Irvine, CA 92697, USA
- Division of Infectious Diseases, Children’s Health of Orange County, Orange, CA 92868, USA
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21
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McKinley CE. "We were always doing something outside. … I had a wonderful, wonderful life": U.S. Indigenous peoples' subsistence, physical activity, and the natural world. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100170. [PMID: 36582621 PMCID: PMC9797056 DOI: 10.1016/j.ssmqr.2022.100170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Obesity tends to be higher, whereas physical activity (PA) tends to be lower for U.S. Indigenous peoples, which drives chronic health problems and mortality. Historical oppression and nutritional colonialism have disrupted Indigenous peoples' subsistence and concomitant PA. The purpose of this research is to use the framework of historical oppression, resilience, and transcendence (FHORT) with 31 participants in a critical ethnography identifying past and present forms of PA. By examining universal themes across two tribal contexts-a Southeast reservation tribal context and an urban Northwestern context-important knowledge about promising forms of PA can inform culturally relevant and effective interventions to promote health and prevent obesity and chronic health problems. Reconstructive thematic qualitative analysis resulted in the following themes: (a) Family-Centered Physical Activity: "The Kids Would … Follow Along, Dropping Seeds and Covering it … the Seeds Grew"; (b) Staying Active in the Natural World: "When I Would Go Home [from boarding school] in the Summertime, That's When … We'll Be Back Being an Indian"; (c) Staying Active through Culture: "The Traditional Dancing … [is] a Form of Exercise"; (d) Mental Wellness in Nature: "It Seemed Like Just Sitting Out There Makes You Feel Better"; and (e) Sports and Competitions Fostering PA: "A lot … Prefer Playing Softball, Basketball, Volleyball, Nowadays". Results highlighted how participants preferred and participated in subsistence and PA growing up, how this had evolved over time, and how being outside in nature contributed to a sense of wellness and overall health.
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22
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Williams DR, Braddock A, Houser M, Blair G, Browne N. Review of upstream social factors contributing to childhood obesity. OBESITY PILLARS 2022; 4:100040. [PMID: 37990668 PMCID: PMC10662005 DOI: 10.1016/j.obpill.2022.100040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 11/23/2023]
Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
| | - Amy Braddock
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Marcella Houser
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Giselle Blair
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Nancy Browne
- The Ohio State University College of Medicine Center for Healthy Weight & Nutrition, Nationwide Children's Hospital, 700 Children's Drive, LA, Suite 5F, Columbus, OH, 43205, USA
- Family and Community Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
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23
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Hiratsuka VY, Reid M, Chang J, Jiang L, Brega AG, Fyfe-Johnson AL, Huyser KR, Johnson-Jennings M, Conway C, Steiner JF, Rockell J, Dillard DA, Moore K, Manson SM, O'Connell J. Associations Between Rurality, pre-pregnancy Health Status, and Macrosomia in American Indian/Alaska Native Populations. Matern Child Health J 2022; 26:2454-2465. [PMID: 36346567 PMCID: PMC10468113 DOI: 10.1007/s10995-022-03536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To examine the relationships between pre-pregnancy diabetes mellitus (DM), gestational diabetes mellitus (GDM), pre-pregnancy body mass index (BMI) and county-level social determinants of health, with infant macrosomia within a sample of American Indian/Alaska Native (AI/AN) women receiving Indian Health Service (IHS) care. METHODS The sample included women-infant dyads representing 1,136 singleton births from fiscal year 2011 (10/1/2019-9/30/2011). Data stemmed from the IHS Improving Health Care Delivery Data Project. Multivariate generalized linear mixed models were fitted to assess the association of macrosomia with pre-pregnancy health status and social determinants of health. RESULTS Nearly half of the women in the sample were under age 25 years (48.6%), and most had Medicaid health insurance coverage (76.7%). Of those with a pre-pregnancy BMI measure, 66.2% were overweight or obese. Although few women had pre-pregnancy DM (4.0%), GDM was present in 12.8% of women. Most women had a normal term delivery (85.4%). Overweight, obesity, pre-pregnancy DM, and county-level rurality were all significantly associated with higher odds of infant macrosomia.
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Affiliation(s)
- Vanessa Y Hiratsuka
- Research Department, Southcentral Foundation, 4501 Diplomacy Drive, 99508, Anchorage, AK, USA.
- Center for Human Development, University of Alaska Anchorage, 3211 Providence Drive, 99508, 99504, Anchorage, AK, USA.
| | - Margaret Reid
- Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado Denver, Denver, USA
| | - Jenny Chang
- Department of Medicine, School of Medicine, University of California, 301 Medical Surge II, 92697-7550, Irvine, CA, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, 3076 AIRB, 92697-7550, Irvine, CA, USA
| | - Angela G Brega
- School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, 13055 East 17th Avenue, 80045, Aurora, Colorado, CO, USA
| | - Amber L Fyfe-Johnson
- Institute for Research and Education to Advance Community Health (IREACH), Department of Medical Education and Clinical Sciences, Washington State University, 1100 Olive Way, Ste 1200, 98101, Seattle, WA, USA
| | - Kimberly R Huyser
- Department of Sociology, The University of British Columbia, Vancouver, USA
| | - Michelle Johnson-Jennings
- Canada Research Chair for Indigenous Community Engaged Research for Indigenous Community Engaged Research, LE Clinical Health Psychologist, University of Saskatchewan, University of Colorado- Associate Professor, University of Washington- Associate Professor, Washington, USA
| | - Cheryl Conway
- NE-BC; Quality Consultant, Charles George Veterans Medical Center, Asheville, NC, USA
| | - John F Steiner
- Institute for Health Research, Department of Medicine, Kaiser Permanente Colorado, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Jennifer Rockell
- Telligen, Inc. Greenwood Village, 7730 E. Belleview Ave Suite 300 Greenwood, 80111, Village, CO, USA
| | - Denise A Dillard
- Research Department, Southcentral Foundation, 4501 Diplomacy Drive, 99508, Anchorage, AK, USA
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
| | - Joan O'Connell
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado, Anschutz Medical Campus, Mail Stop F800, 13055 E. 17th Avenue, 80045, Aurora, CO, USA
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24
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Skouteris H, Green R, Chung A, Bergmeier H, Amir LH, Baidwan SK, Chater A, Chamberlain C, Emond R, Gibbons K, Gooey M, Hatzikiriakidis K, Haycraft E, Hills AP, Higgins DJ, Hooper O, Hunter S, Kappelides P, Kleve S, Krakouer J, Lumeng JC, Manios Y, Mansoor A, Marmot M, Mâsse LC, Matvienko‐Sikar K, Mchiza ZJ, Meyer C, Moschonis G, Munro ER, O'Connor TM, O'Neil A, Quarmby T, Sandford R, Schneiderman JU, Sherriff S, Simkiss D, Spence A, Sturgiss E, Vicary D, Wickes R, Wolfenden L, Story M, Black MM. Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6719-e6729. [PMID: 36401560 PMCID: PMC10946933 DOI: 10.1111/hsc.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.
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Affiliation(s)
- Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
- Warwick Business SchoolUniversity of WarwickCoventryUK
| | - Rachael Green
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Alexandra Chung
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityVictoriaBundooraAustralia
| | | | - Angel Marie Chater
- Centre for Health, Wellbeing and Behaviour ChangeUniversity of BedfordshireLutonUK
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityVictoriaBundooraAustralia
- Centre for Health EquityThe University of MelbourneVictoriaMelbourneAustralia
- Ngangk Yira Research Centre for Aboriginal Health and Social EquityMurdoch UniversityMurdochAustralia
- The Lowitja InstituteCollingwoodVictoriaAustralia
| | | | - Kay Gibbons
- Institute for Health & SportVictoria UniversityVictoriaMelbourneAustralia
| | - Michelle Gooey
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Emma Haycraft
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Andrew P. Hills
- School of Health SciencesUniversity of TasmaniaTasmaniaLauncestonAustralia
| | | | - Oliver Hooper
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | | | - Pam Kappelides
- Department of ManagementLa Trobe UniversityVictoriaBundooraAustralia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, School of Clinical SciencesMonash UniversityVictoriaClaytonAustralia
| | - Jacynta Krakouer
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | | | - Yannis Manios
- Department of Nutrition and DieteticsHarokopio University of AthensAthensGreece
- Institute of Agri‐food and Life SciencesHellenic Mediterranean University Research CentreHeraklionGreece
| | - Athar Mansoor
- The Hong Kong University of Science and TechnologyHong KongHong Kong
| | | | - Louise C. Mâsse
- BC Children's Hospital Research Institute/School of Population and Public HealthUniversity of British ColumbiaBritish ColumbiaVancouverCanada
| | | | - Zandile June‐Rose Mchiza
- Non‐communicable Disease Research Unit, South African Medical Research Council & School of Public Health, Faculty of Community and Health SciencesUniversity of the Western CapeBellvilleSouth Africa
| | - Caroline Meyer
- Executive Office, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and SportLa Trobe UniversityVictoriaBundooraAustralia
| | - Emily R. Munro
- Tilda Goldberg Centre for Social Work and Social CareUniversity of BedfordshireLutonUK
| | - Teresia Margareta O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of PediatricsBaylor College of MedicineTexasHoustonUSA
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of MedicineDeakin UniversityVictoriaGeelongAustralia
| | | | - Rachel Sandford
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Janet U. Schneiderman
- Department of Nursing, Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaCaliforniaLos AngelesUSA
| | | | - Doug Simkiss
- Executive Office, Warwick Medical SchoolUniversity of WarwickCoventryUK
- Birmingham Community Healthcare NHS Foundation TrustBirminghamUK
- Aston UniversityBirminghamUK
| | - Alison Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia
| | | | - Rebecca Wickes
- Griffith Criminology InstituteGriffith UniversityBrisbaneQueenslandAustralia
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Mary Story
- Duke Global Health InstituteDurhamNorth CarolinaUSA
| | - Maureen M. Black
- School of MedicineUniversity of MarylandCollege ParkMarylandUSA
- Research Triangle Institute InternationalResearch Triangle ParkNorth CarolinaUSA
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Naschold F, Porter CM. BMI Status and Trends among Native American Family Members Participating in the Growing Resilience Home Garden Study. Curr Dev Nutr 2022; 6:nzac100. [PMID: 35898313 PMCID: PMC9314720 DOI: 10.1093/cdn/nzac100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 05/17/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
This research reports the BMI status of 176 adults and 134 children from 96 Native American families who are participating in a randomized controlled trial to assess health impacts of home gardens. Analyses include demographic associations with BMI using a novel approach of analyzing BMI status of children and adults together as one population by using LMS-based z scores generated from NHANES data. Results fit national data, with Native Americans more likely to be overweight/obese than other US demographic groups. This, in turn, makes Indigenous communities more vulnerable to chronic diseases. Ending these health inequities requires substantial public health nutrition investments in, for example, restoration of Indigenous foodways. This trial is registered at clinicaltrials.gov as NCT02672748.
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Affiliation(s)
- Felix Naschold
- Department of Economics, University of Wyoming, Laramie, WY, USA
| | - Christine M Porter
- Division of Kinesiology and Health, University of Wyoming, Laramie, WY, USA
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Roubidoux MA, Kaur JS, Rhoades DA. Health Disparities in Cancer Among American Indians and Alaska Natives. Acad Radiol 2022; 29:1013-1021. [PMID: 34802904 DOI: 10.1016/j.acra.2021.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 12/15/2022]
Abstract
American Indians and Alaska Natives (AI/AN) are underserved populations who suffer from several health disparities, 1 of which is cancer. Malignancies, especially cancers of the breast, liver, and lung, are common causes of death in this population. Health care disparities in this population include more limited access to diagnostic radiology because of geographic and/or health system limitations. Early detection of these cancers may be enabled by improving patient and physician access to medical imaging. Awareness by the radiology community of the cancer disparities among this population is needed to support research targeted to this specific ethnic group and to support outreach efforts to provide more imaging opportunities. Providing greater access to imaging facilities will also improve patient compliance with screening recommendations, ultimately improving mortality in these populations.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910, 1500 E. Medical Center Drive, Ann Arbor, Mi 48109-5326.
| | - Judith S Kaur
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida
| | - Dorothy A Rhoades
- Department of Internal Medicine, Stephenson Cancer Center and the University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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27
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Browne NT, Hodges EA, Small L, Snethen JA, Frenn M, Irving SY, Gance-Cleveland B, Greenberg CS. Childhood obesity within the lens of racism. Pediatr Obes 2022; 17:e12878. [PMID: 34927392 DOI: 10.1111/ijpo.12878] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/28/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
Abstract
Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action.
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Affiliation(s)
| | - Eric A Hodges
- UNC-Chapel Hill School of Nursing, Chapel Hill, North Carolina, USA
| | - Leigh Small
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Julia A Snethen
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin, USA
| | - Marilyn Frenn
- Marquette University College of Nursing, Milwaukee, Wisconsin, USA
| | - Sharon Y Irving
- Pediatric Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Cindy Smith Greenberg
- College of Health and Human Development, California State University, Fullerton, California, USA
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Kills First CC, Sutton TL, Shannon J, Brody JR, Sheppard BC. Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs. Cancer 2022; 128:1560-1567. [PMID: 35132620 PMCID: PMC10257521 DOI: 10.1002/cncr.34118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/22/2021] [Accepted: 12/23/2021] [Indexed: 11/07/2022]
Abstract
Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high-quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population-level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high-quality care for pancreatic cancer and other lethal malignancies.
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Affiliation(s)
| | | | | | - Jonathan R. Brody
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
| | - Brett C. Sheppard
- OHSU, Department of Surgery, Portland, OR, 97239
- OHSU Brenden-Colson Center for Pancreatic Care, Portland, OR, 97239
- OHSU, Department of Cell, Developmental and Cancer Biology, Knight Cancer Institute, Portland, OR, 97239
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29
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Jock BW, Maudrie T, Fleischhacker S, Porter KP, Gittelsohn J. Journey to Promoting Structural Change for Chronic Disease Prevention: Examining the Processes for Developing Policy, Systems, and Environmental Supports in Native American Nations. Curr Dev Nutr 2022; 6:nzab031. [PMID: 35310617 PMCID: PMC8923812 DOI: 10.1093/cdn/nzab031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/23/2020] [Accepted: 03/31/2021] [Indexed: 11/29/2022] Open
Abstract
Background Obesity and chronic disease rates continue to be disproportionally high among Native Americans (NAs) compared with the US general population. Policy, systems, and environmental (PSE) changes can address the root causes of these health inequalities by supporting access to healthy food and physical activity resources. Objective We aim to describe the actors and processes involved in developing PSE changes supporting obesity prevention in NA Nations. Methods As part of the Obesity Prevention Research and Evaluation of InterVention Effectiveness in NaTive North Americans 2 (OPREVENT2) trial (ClinicalTrials.gov registration: NCT02803853), we collected 46 in-depth interviews, 1 modified Talking Circle, 2 workshops, and 14 observations in 3 NA communities in the Midwest and Southwest regions of the United States. Participants included Tribal government representatives/staff, health staff/board members, store managers/staff, and school administrators/staff. We used a Grounded Theory analysis protocol to develop themes and conceptual framework based on our data. Results Health staff members were influential in identifying and developing PSE changes when there was a strong relationship between the Tribal Council and health department leaders. We found that Tribal Council members looked to health staff for their expertise and were involved in the approval and endorsement of PSE changes. Tribal grant writers worked across departments to leverage existing initiatives, funding, and approvals to achieve PSE changes. Participants emphasized that community engagement was a necessary input for developing PSE changes, suggesting an important role for grassroots collaboration with community members and staff. Relevant contextual factors impacting the PSE change development included historical trauma, perspectives of policy, and "tribal politics". Conclusions This article is the first to produce a conceptual framework using 3 different NA communities, which is an important gap to be addressed if structural changes are to be explored and enacted to promote NA health. The journey to change for these NA Nations provides insights for promoting future PSE change among NA Nations and communities.
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Affiliation(s)
- Brittany Wenniserí:iostha Jock
- School of Human Nutrition, Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, St-Anne-de-Bellevue, Quebec, Canada
| | - Tara Maudrie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Blue Bird Jernigan V, Taniguchi T, Haslam A, Williams MB, Maudrie TL, Nikolaus CJ, Wetherill MS, Jacob T, Love CV, Sisson S. Design and Methods of a Participatory Healthy Eating Intervention for Indigenous Children: The FRESH Study. Front Public Health 2022; 10:790008. [PMID: 35296044 PMCID: PMC8920553 DOI: 10.3389/fpubh.2022.790008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/26/2022] [Indexed: 12/23/2022] Open
Abstract
Objective To increase vegetable and fruit intake, reduce body mass index (BMI), and improve parental blood pressure among American Indian families. Design Randomized, wait-list controlled trial testing a multi-level (environmental, community, family, and individual) multi-component intervention with data collection at baseline and 6 months post-intervention. Setting Tribally owned and operated Early Childhood Education (ECE) programs in the Osage Nation in Oklahoma. Participants American Indian families (at least one adult and one child in a ECE program). A sample size of 168 per group will provide power to detect differences in fruit and vegetable intake. Intervention The 6-month intervention consisted of a (1) ECE-based nutrition and gardening curriculum; (2) nutrition education and food sovereignty curriculum for adults; and (3) ECE program menu modifications. Main Outcome Measures The primary outcome is increase in fruit and vegetable intake, assessed with a 24-h recall for adults and plate weight assessments for children. Secondary outcomes included objective measures of BMI among adults and children and blood pressure among adults.
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Affiliation(s)
- Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States,*Correspondence: Valarie Blue Bird Jernigan
| | - Tori Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Alyson Haslam
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Mary B. Williams
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
| | - Tara L. Maudrie
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cassandra J. Nikolaus
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, United States
| | - Marianna S. Wetherill
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK, United States
| | - Tvli Jacob
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Charlotte V. Love
- School of Health Care Administration, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Susan Sisson
- Department of Nutritional Sciences, University of Oklahoma College of Allied Health, Oklahoma City, OK, United States
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31
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Haslam A, Love C, Taniguchi T, Williams MB, Wetherill MS, Sisson S, Weedn AE, Jacob T, Jernigan VBB. Development and Implementation of a Hybrid Online and In-Person Food Sovereignty and Nutrition Education Curriculum for Native American Parents: The FRESH Study. HEALTH EDUCATION & BEHAVIOR 2022; 50:430-440. [PMID: 34991400 PMCID: PMC9981305 DOI: 10.1177/10901981211067168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Food Resource Equity and Sustainability for Health ("FRESH") study is an Indigenous-led intervention to increase vegetable and fruit intake among Native American children. As part of this study, we developed a hybrid (online and in-person) food sovereignty and nutrition education curriculum for the parents of these children. This 16-week curriculum was developed to promote household- and community-level healthy eating and food sovereignty practices to parents of preschool-aged children residing in Osage Nation, Oklahoma. A total of 81 parent/caregivers participated in the curriculum component of the FRESH study, with a median age of 34 years (range: 23-54 years). Most study participants were female (88.9%) and less than half (45.7%) had an annual household income of more than US$50,000. Most were married or had a significant other (76.5%) and worked full-time (65.4%). The median total number of children in the home <18 years of age was three (range: 1-8). Participation among the 94 parents was 56% during the first week and was 12% in the final week. Having some college or technical training (vs. having a college degree) and having an annual household income of US$20,000-US$50,000 (vs. more than US$50,000) were associated with fewer sessions attended (p = 0.004 and 0.02, respectively) Being married (vs. not) was associated with higher attendance (p < .0001). Participation in a hybrid food sovereignty and nutrition education curriculum for parents was generally low, but income, education, and marital status were associated with curriculum participation. Our research adds to the literature by describing the development and implementation of this curriculum and recommendations for future research incorporating Indigenous approaches to health.
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Affiliation(s)
- Alyson Haslam
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | - Susan Sisson
- The University of Oklahoma—Tulsa, Tulsa, OK, USA
| | | | - Tvli Jacob
- Oklahoma State University, Tulsa, OK, USA
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Engaging School and Family in Navajo Gardening for Health: Development of the Yéego Intervention to Promote Healthy Eating among Navajo Children. HEALTH BEHAVIOR AND POLICY REVIEW 2021; 8:212-222. [PMID: 34901297 DOI: 10.14485/hbpr.8.3.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective Navajo children are at increased risk for obesity, in part due to limited access to healthy foods. School garden interventions have been shown to increase access to fresh fruit and vegetables and consumption of healthy foods. Our study describes the development and pilot testing of a school garden intervention for Navajo elementary school children. Methods We reviewed existing school garden interventions and conducted formative research with students, caregivers, and school staff to inform the intervention. The intervention consisted of a garden built at the school and a yearlong curriculum on gardening and healthy eating. We pilot tested the intervention in an elementary school on the Navajo Nation. Results Formative research revealed the importance of incorporating Diné culture, including traditional growing practices and the preparation of traditional foods into the curriculum. School staff also stressed the value of tying the curriculum to state and Diné educational standards. Students enjoyed opportunities for hands-on activities and snack preparation. Conclusions Schools have a meaningful role to play in addressing childhood obesity disparities among Navajo children. School-based interventions that draw on cultural strengths and include healthy traditional practices can be a promising strategy for increasing fruit and vegetable consumption.
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Contributors to reduced life expectancy among Native Americans in the Four Corners States. PLoS One 2021; 16:e0256307. [PMID: 34403430 PMCID: PMC8370614 DOI: 10.1371/journal.pone.0256307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
To assess trends in life expectancy and the contribution of specific causes of death to Native American-White longevity gaps in the Four Corners states, we used death records from the National Center for Health Statistics and population estimates from the U.S. Census Bureau from 1999–2017 to generate period life tables and decompose racial gaps in life expectancy. Native American-White life expectancy gaps narrowed between 2001 and 2012 but widened thereafter, reaching 4.92 years among males and 2.06 years among females in 2015. The life expectancy disadvantage among Native American males was primarily attributable to motor vehicle accidents (0.96 years), liver disease (1.22 years), and diabetes (0.78 years). These causes of deaths were also primary contributors to the gap among females, forming three successive waves of mortality that occurred in young adulthood, midlife, and late adulthood, respectively, among Native American males and females. Interventions to reduce motor vehicle accidents in early adulthood, alcohol-related mortality in midlife, and diabetes complications at older ages could reduce Native American-White longevity disparities in the Four Corners states.
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Maudrie TL, Colón-Ramos U, Harper KM, Jock BW, Gittelsohn J. A Scoping Review of the Use of Indigenous Food Sovereignty Principles for Intervention and Future Directions. Curr Dev Nutr 2021; 5:nzab093. [PMID: 34345758 PMCID: PMC8321882 DOI: 10.1093/cdn/nzab093] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 05/11/2021] [Accepted: 06/28/2021] [Indexed: 12/19/2022] Open
Abstract
Indigenous food sovereignty (IFS) represents a community-led movement with potential to reduce health inequities, but no scoping review of the impact of taking an IFS approach on intervention research has been conducted. This review sought to: 1) describe intervention studies that employ IFS principles, and 2) describe the impact of studies using IFS principles on food access, eating patterns, diet quality, physical activity, and health. Through a literature review, 4 IFS principles were identified: 1) community ownership, 2) inclusion of traditional food knowledge, 3) inclusion and promotion of cultural foods, and 4) environmental/intervention sustainability. Twenty intervention studies published between January 1, 2000 and February 5, 2020 were included. Most of the studies that scored high in IFS principles saw a positive impact on diet. This review found evidence supporting the value of IFS principles in the development, implementation, and evaluation of health interventions for Indigenous communities.
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Affiliation(s)
- Tara L Maudrie
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Uriyoán Colón-Ramos
- Department of Global Health, Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health at The George Washington University, Washington, DC, USA
| | - Kaitlyn M Harper
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brittany W Jock
- School of Human Nutrition, Centre for Indigenous Peoples’ Nutrition and Environment (CINE), McGill University, Montreal, Quebec, Canada
| | - Joel Gittelsohn
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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35
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Resilience-promoting policies and contexts for children of color in the United States: Existing research and future priorities. Dev Psychopathol 2021; 33:614-624. [PMID: 33955340 DOI: 10.1017/s095457942000173x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The health status of children in the United States varies by racial and ethnic, shaped by an interrelated set of systems that disadvantage children of color in the United States. In this article, we argue for a broad view of resilience, in both research and policy, that views resilience not just as a property of individuals but also as a characteristic of social contexts and policies. Accordingly, we describe the empirical evidence for policies and contexts as factors that can improve health among children and families that are deprived of equal opportunities and resources due to structural racism. We discuss the evidence and opportunities for policies and interventions across a variety of societal systems, including programs to promote economic and food security, early education, health care, and the neighborhood and community context. Based on this evidence and other research on racism and resilience, we conclude by outlining some directions for future research.
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36
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Tomayko EJ, Webber EJ, Cronin KA, Prince RJ, Adams AK. Use of Text Messaging and Facebook Groups to Support the Healthy Children, Strong Families 2 Healthy Lifestyle Intervention for American Indian Families. Curr Dev Nutr 2021; 5:32-39. [PMID: 34222765 PMCID: PMC8242221 DOI: 10.1093/cdn/nzaa110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few obesity interventions have been developed for American Indian (AI) families despite the disproportionate risk of obesity experienced within AI communities. The emergence of mobile technologies to enhance intervention delivery could particularly benefit AI communities, many of which are hard to reach and underserved. OBJECTIVES This study aimed to assess the use and perceptions of text messaging and Facebook to support delivery of the Healthy Children, Strong Families 2 (HCSF2) mailed healthy lifestyle/obesity prevention intervention and discuss lessons learned regarding intervention support via these platforms among AI participants. METHODS From among AI families with young children (ages 2-5 y), 450 adult-child dyads were recruited from 5 rural and urban communities for a year-long intervention. Intervention content was delivered by mail and supported by text messaging and optional Facebook groups. Participants provided feedback on text message and Facebook components post-intervention, and Facebook analytic data were tracked. RESULTS Self-report feedback indicated high satisfaction with both text messaging and Facebook, with tangible content (e.g., recipes, physical activity ideas) cited as most useful. Overall, participants reported higher satisfaction with and perceived efficacy of Facebook content compared with text messaging. Analytic data indicate the optional HCSF2 Facebook groups were joined by 67.8% of adult participants. Among those who joined, 78.4% viewed, 50.8% "liked," and 22.6% commented on ≥1 post. Engagement levels differed by urban-rural status, with more urban participants "liking" (P = 0.01) and commenting on posts (P = 0.01). Of note, nearly one-third of participants reported changing phone numbers during the intervention. CONCLUSIONS This study demonstrates high satisfaction regarding mobile delivery of HCSF2 intervention support components. Best practices and challenges in utilizing different mobile technologies to promote wellness among AI families are discussed, with particular focus on urban-rural differences. Future mobile-based interventions should consider the context of unstable technology maintenance, especially in low-resource communities.This work is part of the HCSF2 trial, which is registered at clinicaltrials.gov (NCT01776255).
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Affiliation(s)
- Emily J Tomayko
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
| | - Eliza J Webber
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
| | - Kate A Cronin
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ronald J Prince
- Department of Population Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alexandra K Adams
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
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Wahi G, de Souza RJ, Hartmann K, Giglia L, Jack SM, Anand SS. Effectiveness of programs aimed at obesity prevention among Indigenous children: A systematic review. Prev Med Rep 2021; 22:101347. [PMID: 33889482 PMCID: PMC8050026 DOI: 10.1016/j.pmedr.2021.101347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/30/2020] [Accepted: 02/20/2021] [Indexed: 01/03/2023] Open
Abstract
Given the significant health burden of childhood obesity, it is imperative that effective programs be better understood. When evaluating obesity prevention efforts, one must recognize the contextual factors which drive the disproportionate risk of obesity between populations. This systematic review sought to understand if programs aimed at obesity prevention and/or the promotion of healthy lifestyle behaviours for Indigenous children are effective. We conducted a search using Medline, EMBASE, PsychINFO, ERIC, CINAHL and iPORTAL databases from inception to August 13, 2019. We included experimental and quasi-experimental studies. The main outcomes of interest were change in anthropometrics, nutrition or physical activity. Our narrative synthesis included an assessment of study quality using the Effective Public Health Practice Project Quality assessment tool. A total of 34 studies met selection criteria. Most studies used a quasi-experimental design (n = 25) and were assessed as low to moderate quality (n = 32). Three studies showed a significant change in anthropometric measures, 14 studies demonstrated at least one significant nutrition-related behaviour or dietary-pattern change, and six studies demonstrated a significant impact on physical activity. This systematic review of programs to prevent obesity among Indigenous children finds a limited impact on anthropometric measurements. Future studies must prioritize Indigenous knowledge and ways of knowing to lead all phases of development, implementation, and evaluation of programs.
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Affiliation(s)
- Gita Wahi
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Katrina Hartmann
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Lucia Giglia
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- School of Nursing, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Canada
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Rao G, Jensen ET. Type 2 Diabetes in Youth. Glob Pediatr Health 2021; 7:2333794X20981343. [PMID: 34036121 PMCID: PMC8126957 DOI: 10.1177/2333794x20981343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/07/2020] [Accepted: 11/24/2020] [Indexed: 01/21/2023] Open
Abstract
The incidence of type 2 diabetes in children and adolescents in the United States
rose at an annual rate of 4.8% between 2002-2003 and 2014-2015. Type 2 diabetes
progresses more aggressively to complications than type 1 diabetes. For example,
in one large epidemiological study, proliferative retinopathy affected 5.6% and
9.1% of children with type 1 and type 2 diabetes, respectively. Screening begins
at age 10 or at onset of puberty, and is recommended among children with a BMI%
≥85 with risk factors such as a family history and belonging to a high risk
racial or ethnic or racial group. HbA1C% is preferred for screening as it does
not require fasting. As distinguishing between type 1 and type 2 diabetes is not
straightforward, all children with new onset disease should undergo autoantibody
testing. Results of lifestyle interventions for control of type 2 diabetes have
been disappointing, but are still recommended for their educational value and
the potential impact upon some participants. There is limited evidence for the
benefit of newer mediations. Liraglutide, a GLP-1 agonist, however, has been
shown to significantly reduce HbA1C% in one study and is now approved for
children. Liraglutide should be considered as second line therapy.
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Affiliation(s)
- Goutham Rao
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA
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Matsuzaki M, Sánchez BN, Rebanal RD, Gittelsohn J, Sanchez-Vaznaugh EV. California and federal school nutrition policies and obesity among children of Pacific Islander, American Indian/Alaska Native, and Filipino origins: Interrupted time series analysis. PLoS Med 2021; 18:e1003596. [PMID: 34029318 PMCID: PMC8143391 DOI: 10.1371/journal.pmed.1003596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity prevalence remains high among children of Pacific Islander (PI) origin, Filipino (FI), and American Indian/Alaska Native (AIAN) origins in the United States. While school nutrition policies may help prevent and reduce childhood obesity, their influences specifically among PI, FI, and AIAN children remain understudied. We evaluated the association of the California (CA) state school nutrition policies for competitive food and beverages and the federal policy for school meals (Healthy, Hunger-Free Kids Act of 2010 (HHFKA 2010)) with overweight/obesity among PI, FI, and AIAN students. METHODS AND FINDINGS We used an interrupted time series (ITS) design with FitnessGram data from 2002 to 2016 for PI (78,841), FI (328,667), AIAN (97,129), and White (3,309,982) students in fifth and seventh grades who attended CA public schools. Multilevel logistic regression models estimated the associations of the CA school nutrition policies (in effect beginning in academic year 2004 to 2005) and HHFKA 2010 (from academic year 2012 to 2013) with overweight/obesity prevalence (above the 85 percentile of the age- and sex-specific body mass index (BMI) distribution). The models were constructed separately for each grade and sex combination and adjusted for school district-, school-, and student-level characteristics such as percentage of students eligible for free and reduced price meals, neighborhood income and education levels, and age. Across the study period, the crude prevalence of overweight/obesity was higher among PI (39.5% to 52.5%), FI (32.9% to 36.7%), and AIAN (37.7% to 45.6%) children, compared to White (26.8% to 30.2%) students. The results generally showed favorable association of the CA nutrition policies with overweight/obesity prevalence trends, although the magnitudes of associations and strengths of evidence varied among racial/ethnic subgroups. Before the CA policies went into effect (2002 to 2004), overweight/obesity prevalence increased for White, PI, and AIAN students in both grades and sex groups as well as FI girls in seventh grade. After the CA policies took place (2005 to 2012), the overweight/obesity rates decreased for almost all subgroups who experienced increasing trends before the policies, with the largest decrease seen among PI girls in fifth grade (before: log odds ratio = 0.149 (95% CI 0.108 to 0.189; p < 0.001); after: 0.010 (-0.005 to 0.025; 0.178)). When both the CA nutrition policies and HHFKA 2010 were in effect (2013 to 2016), declines in the overweight/obesity prevalence were seen among White girls and FI boys in fifth grade. Despite the evidence of the favorable association of the school nutrition policies with overweight/obesity prevalence trends, disparities between PI and AIAN students and their White peers remained large after the policies took place. As these policies went into effect for all public schools in CA, without a clear comparison group, we cannot conclude that the changes in prevalence trends were solely attributable to these policies. CONCLUSIONS The current study found evidence of favorable associations of the state and federal school nutrition policies with overweight/obesity prevalence trends. However, the prevalence of overweight/obesity continued to be high among PI and AIAN students and FI boys. There remain wide racial/ethnic disparities between these racial/ethnic minority subgroups and their White peers. Additional strategies are needed to reduce childhood obesity and related disparities among these understudied racial/ethnic populations.
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Affiliation(s)
- Mika Matsuzaki
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, Baltimore, Maryland, United States of America
| | - Brisa N. Sánchez
- Drexel University Dornsife School of Public Health, Department of Biostatistics, Philadelphia, Pennsylvania, United States of America
| | - R. David Rebanal
- San Francisco State University, Health Equity Institute, San Francisco, California, United States of America
- San Francisco State University, Department of Public Health, San Francisco, California, United States of America
| | - Joel Gittelsohn
- Johns Hopkins Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, Baltimore, Maryland, United States of America
| | - Emma V. Sanchez-Vaznaugh
- San Francisco State University, Health Equity Institute, San Francisco, California, United States of America
- San Francisco State University, Department of Public Health, San Francisco, California, United States of America
- University of California San Francisco, Center for Health Equity, San Francisco, California, United States of America
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Abstract
American Indian and Alaska Native (AI/AN) populations have substantial health inequities, and most of their disease entities begin in childhood. In addition, AI/AN children and adolescents have excessive disease rates compared with the general pediatric population. Because of this, providers of pediatric care are in a unique position not only to attenuate disease incidence during childhood but also to improve the health status of this special population as a whole. This policy statement examines the inequitable disease burden observed in AI/AN youth, with a focus on toxic stress, mental health, and issues related to suicide and substance use disorder, risk of and exposure to injury and violence in childhood, obesity and obesity-related cardiovascular risk factors and disease, foster care, and the intersection of lesbian, gay, bisexual, transgender, queer, and Two-Spirit and AI/AN youth. Opportunities for advocacy in policy making also are presented.
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Affiliation(s)
- Shaquita Bell
- Departments of Pediatrics and
- Contributed equally as co-first authors
| | - Jason F Deen
- Departments of Pediatrics and
- Contributed equally as co-first authors
| | - Molly Fuentes
- Rehabilitation Medicine, School of Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington; and
| | - Kelly Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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McKerchar C, Lacey C, Abel G, Signal L. Ensuring the right to food for indigenous children: a case study of stakeholder perspectives on policy options to ensure the rights of tamariki Māori to healthy food. Int J Equity Health 2021; 20:67. [PMID: 33639956 PMCID: PMC7910759 DOI: 10.1186/s12939-021-01407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The United Nations Convention on the Rights of the Child confirms a child's right to adequate food, and to the highest attainable standard of health. For indigenous children, these rights are also recognised in the UN Declaration on the Rights of Indigenous Peoples. However, Indigenous children endure higher rates of obesity and related health conditions than non-indigenous children, including in Aotearoa New Zealand (NZ). For indigenous tamariki (Māori children) in NZ, high levels of obesity are interconnected with high rates of food insecurity. Therefore there is a need for action. This study aimed to investigate policy options that would safeguard the rights of indigenous children to healthy food. We explored with key stakeholder's policy options to ensure the rights of indigenous children to healthy food, through a case study of the rights of tamariki. METHODS Interviews were conducted with 15 key stakeholders, with experience in research, development or delivery of policies to safeguard the rights of tamariki to healthy food. Iterative thematic analysis of the transcripts identified both deductive themes informed by Kaupapa Māori theory and literature on rights-based approaches and inductive themes from the interviews. RESULTS The analysis suggests that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children's rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making. CONCLUSIONS The right to food for indigenous children, is linked to political and economic systems that are an outcome of colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes is needed. Given the importance of food to health, a broad policy approach from the NZ government to ensure the right to adequate food is urgent. This includes economic policies to end child poverty and specific strategies such as food provision and food policy in schools. The role of Iwi (tribes) and local governments needs to be further explored if we are to improve the right to adequate food within regions of NZ.
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Affiliation(s)
- Christina McKerchar
- Department of Population Health, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Cameron Lacey
- Māori/Indigenous Health Institute, University of Otago, PO Box 4345, 8140, Christchurch, New Zealand
| | - Gillian Abel
- Department of Population Health, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand
| | - Louise Signal
- Department of Public Health, University of Otago, PO Box 7343, Wellington, South Wellington, 6242, New Zealand
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Ducharme-Smith K, Chambers R, Garcia-Larsen V, Larzelere F, Kenney A, Reid R, Nelson L, Richards J, Begay M, Barlow A, Rosenstock S. Native Youth Participating in the Together on Diabetes 12-Month Home-Visiting Program Reported Improvements in Alternative Healthy Eating Index-2010 Diet Quality Domains Likely to Be Associated With Blood Pressure and Glycemic Control. J Acad Nutr Diet 2021; 121:1125-1135. [PMID: 33547030 DOI: 10.1016/j.jand.2020.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 12/08/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Together on Diabetes (TOD) intervention was a home-visiting diabetes prevention and management program for Native youth. OBJECTIVES (1) Examine the impact of the TOD program on diet quality using the Alternative Healthy Eating Index (AHEI-2010); (2) determine association between diet quality and cardiometabolic health. DESIGN The TOD program was conducted from October 2012 to June 2014 and was evaluated using a pretest-posttest study design from baseline to 12 months. Dietary intake was assessed using a food frequency questionnaire. PARTICIPANTS/SETTING There were 240 participants between 10 and 19 years of age from 4 reservation-based, rural tribal communities in the southwestern United States that had been diagnosed with T2DM or prediabetes or were identified as at risk based on body mass index and a qualifying laboratory test. INTERVENTION Youth were taught a 12-lesson curriculum on goal setting, nutrition, and life skills education. MAIN OUTCOME MEASURES Behavioral and physiologic outcomes related to diabetes. STATISTICAL ANALYSIS Changes in AHEI-2010 score and associations with cardiometabolic measures were tested, over time, using adjusted longitudinal linear mixed-effects models. RESULTS The study sample reported an average energy intake of 2016 kcal/d (±1260) and AHEI-2010 score of 47.4 (±7.4) (range: 0-110, higher = better diet quality), indicating low diet quality at baseline. At 12 months' follow-up, there was a reduction in kilocalories (mean = -346 kcal/d; P < .001), sugar-sweetened beverages (mean = -2 fluid oz/d; P = .032), red/processed meat (mean = -1.5 oz/d; P = .008), and sodium (mean = -650 mg/d; P < .001) but no change in AHEI-2010 score (P = .600). The change in systolic blood pressure from baseline to 12 months for participants within the highest AHEI-2010 quartile group was significantly larger than the change in participants within the lowest quartile group (mean = -5.90 mm Hg; P = .036). CONCLUSIONS Despite stable AHEI-2010 scores during follow-up, there were improvements in diet quality domains likely to be associated with cardiometabolic health. Home-visiting programs like TOD are promising interventions for decreasing dietary intake of poor-quality foods.
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Bleich SN, Ard JD. COVID-19, Obesity, and Structural Racism: Understanding the Past and Identifying Solutions for the Future. Cell Metab 2021; 33:234-241. [PMID: 33465335 PMCID: PMC8807028 DOI: 10.1016/j.cmet.2021.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Long-standing systemic inequalities-fueling unequal access to critical resources such as healthcare, housing, education, and employment opportunities-are largely responsible for the significant race disparities in obesity and COVID-19. Because of this legacy, public health emergencies like the COVID-19 pandemic disproportionately impact communities of color, exacerbated by high rates of pre-existing chronic diseases like obesity. Learning from this history is instructive for understanding our present situation and for crafting effective solutions that promote health equity. Critical action is needed now to meaningfully address the disproportionate impact of these major public health problems on Black and Brown populations.
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Affiliation(s)
- Sara N Bleich
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Rosenstock S, Ingalls A, Foy Cuddy R, Neault N, Littlepage S, Cohoe L, Nelson L, Shephard-Yazzie K, Yazzie S, Alikhani A, Reid R, Kenney A, Barlow A. Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:133-142. [PMID: 33165594 PMCID: PMC7653536 DOI: 10.1001/jamapediatrics.2020.3557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
Importance Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population. Objective To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum. Design, Setting, and Participants This study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted. Interventions The 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons. Main Outcomes and Measures Primary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs). Results A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, -0.67; 95% CI, -0.04 to -1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, -0.54; 95% CI, -0.94 to -0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, -0.46; 95% CI, -0.92 to 0.01). Conclusions and Relevance Infants of Native American mothers who participated in a home-visiting intervention had substantially lower SSB consumption and improvements in responsive feeding practices and infant zBMI scores, suggesting the intervention is effective for promoting healthy infant feeding and growth. Trial Registration ClinicalTrials.gov Identifier: NCT03101943.
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Affiliation(s)
- Summer Rosenstock
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Reese Foy Cuddy
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole Neault
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shea Littlepage
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Cohoe
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leonela Nelson
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kimberlyn Shephard-Yazzie
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shaneyka Yazzie
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anna Alikhani
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, Rhode Island
| | - Raymond Reid
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Kenney
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Prevalence and Correlates of Disinhibited Eating in Youth from Marginalized Racial/Ethnic Groups. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-020-00347-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Andreo CL, Andrade JM. Determining Effective Nutrition Intervention Strategies and the Subsequent Impact on Nutrition Knowledge, Dietary Adherence, and Health Outcomes among American Indian/Alaska Native Youth (2-18 Years of Age): a Systematic Review. J Racial Ethn Health Disparities 2020; 7:1202-1213. [PMID: 32270432 DOI: 10.1007/s40615-020-00745-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/15/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
The PRISMA style literature review was used to determine effective nutrition intervention strategies and their subsequent impact on nutrition knowledge, dietary adherence, and health outcomes among American Indian/Alaskan Native (AI/AN) youth. Peer-reviewed articles published between January 1980 and December 2019 were extracted from PubMed, CINAHL, Cochrane, and PsychInfo databases. A 4-point inclusion criterion was established to include articles with AI/AN youth, nutrition intervention, and presented health outcomes. A quality criteria checklist was used to assess the articles. A total of 12 studies were included in this study. Interventions that incorporated cultural adaptations (e.g., storytelling), theoretical frameworks (e.g., community-based participatory), active learning (e.g., cooking), tribal partnership, and caregiver involvement slightly improved nutrition knowledge, dietary adherence, and health outcomes. Overall, this review revealed that incorporating cultural aspects with input from the community in a nutrition program has a positive impact on AI/AN youths. Steps can be taken at the policy level to direct obesity and non-communicable disease prevention efforts among AI/AN youth.
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Affiliation(s)
- Cecelia L Andreo
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, 32611, USA
| | - Jeanette M Andrade
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL, 32611, USA.
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Vazquez CE, Cubbin C. Socioeconomic Status and Childhood Obesity: a Review of Literature from the Past Decade to Inform Intervention Research. Curr Obes Rep 2020; 9:562-570. [PMID: 32785878 DOI: 10.1007/s13679-020-00400-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This is a review of the patterns, conceptualization, and suggested mechanisms underlying the relationship of socioeconomic status (SES) to obesity in childhood and the implications of these data for interventions going forward. RECENT FINDINGS Adiposity and SES are negatively associated in high-income countries and positively associated in medium to low-income countries. Several mechanisms, such as early introduction of solid food and parental behaviors, which may explain the association of SES and adiposity, have been identified. Parental education and adiposity and early pediatric nutrition appear to be particularly salient SES-related effectors on adiposity. There is a clear association of SES and adiposity which is affected by population affluence. Evaluation of the relationship of SES and obesity in children are complicated by the complexity of SES and lack of common definition. A number of SES-related interventional targets have been identified. Intervention research should ensure they are addressing SES-associated issues in the study population.
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Affiliation(s)
- Christian E Vazquez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA.
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
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Burrows NR, Zhang Y, Hora I, Pavkov ME, Sheff K, Imperatore G, Bullock AK, Albright AL. Sustained Lower Incidence of Diabetes-Related End-Stage Kidney Disease Among American Indians and Alaska Natives, Blacks, and Hispanics in the U.S., 2000-2016. Diabetes Care 2020; 43:2090-2097. [PMID: 32616609 PMCID: PMC8628545 DOI: 10.2337/dc20-0495] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/23/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes-related end-stage kidney disease (ESKD-D) disproportionately affects U.S. racial/ethnic minority populations compared with whites. However, from 1996 to 2013, ESKD-D incidence among American Indians and Alaska Natives (AIANs) and blacks declined. We assessed recent ESKD-D incidence data to determine whether trends by race/ethnicity have changed since 2013. RESEARCH DESIGN AND METHODS United States Renal Data System data from 2000 to 2016 were used to determine the number of whites, blacks, AIANs, Asians, and Hispanics aged ≥18 years with newly treated ESKD-D (with diabetes listed as primary cause). Using census population estimates as denominators, annual ESKD-D incidence rates were calculated and age adjusted to the 2000 U.S. standard population. Joinpoint regression was used to analyze trends and estimate an average annual percent change (AAPC) in incidence rates. RESULTS For adults overall, from 2000 to 2016, age-adjusted ESKD-D incidence rates decreased by 53% for AIANs (66.7-31.2 per 100,000, AAPC -4.5%, P < 0.001), by 33% for Hispanics (50.0-33.3, -2.1%, P < 0.001), and by 20% for blacks (56.2-44.7, -1.6%, P < 0.001). However, during the study period, age-adjusted ESKD-D incidence rates did not change significantly for Asians and increased by 10% for whites (15.4-17.0, 0.6%, P = 0.01). In 2016, ESKD-D incidence rates in AIANs, Hispanics, and blacks were ∼2.0-2.5 times higher than whites. CONCLUSIONS ESKD-D incidence declined for AIANs, Hispanics, and blacks and increased for whites. Continued efforts might be considered to reverse the trend in whites and sustain and lower ESKD-D incidence in the other populations.
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Affiliation(s)
- Nilka Ríos Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yan Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Israel Hora
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Karen Sheff
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ann K Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, MD
| | - Ann L Albright
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Jones LJ, VanWassenhove-Paetzold J, Thomas K, Bancroft C, Ziatyk EQ, Kim LSH, Shirley A, Warren AC, Hamilton L, George CV, Begay MG, Wilmot T, Tsosie M, Ellis E, Selig SM, Gall G, Shin SS. Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children. Curr Dev Nutr 2020; 4:nzaa109. [PMID: 32734135 PMCID: PMC7377262 DOI: 10.1093/cdn/nzaa109] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. OBJECTIVES We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. METHODS Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values. RESULTS A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P < 0.001). Sixty-five percent of children were retained in the program. CONCLUSIONS The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.
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Affiliation(s)
- Leandra J Jones
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Joan VanWassenhove-Paetzold
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Kymie Thomas
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carolyn Bancroft
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - E Quinn Ziatyk
- Chinle Comprehensive Health Care Facility, Chinle, Arizona
| | | | - Ariel Shirley
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Abigail C Warren
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Lindsey Hamilton
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carmen V George
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative Outreach Program, Navajo Department of Health, Window Rock, Arizona
| | - Taylor Wilmot
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Memarie Tsosie
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Emilie Ellis
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Sara M Selig
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gail Gall
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Sonya S Shin
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Northern Navajo Medical Center, Shiprock, New Mexico
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50
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Cueva K, Speakman K, Neault N, Richards J, Lovato V, Parker S, Carroll D, Sundbo A, Barlow A. Cultural Connectedness as Obesity Prevention: Indigenous Youth Perspectives on Feast for the Future. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:632-639. [PMID: 31924560 DOI: 10.1016/j.jneb.2019.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe a community-based obesity-prevention initiative that promoted cultural connectedness and traditional food revitalization and gained insight into youth participants' perspectives on the program through a photovoice methodology. METHODS Photovoice methods were used with fourth- and fifth-grade youths (aged 9-11 years) in the US Southwest who had participated in the Feast for the Future program. A total of 44 youths from 3 communities met for 8-9 sessions; they took photos of current food environments and traditional food systems, and discussed them as well as Feast for the Future and hopes for the future, and then prepared a final presentation. Photovoice sessions were recorded, transcribed verbatim, then open coded using Atlas.ti. RESULTS Five common themes emerged: traditional food is farmed or gardened, traditional foods are healthy, Feast for the Future supported positive connections to culture, hope for more farming or gardening for future generations, and store or less nutrient-dense food is unhealthy. CONCLUSIONS AND IMPLICATIONS Photovoice can be an effective way to engage Indigenous youths in conversations about their culture and food environments. The findings suggest that attention to revitalizing traditional food systems and supporting cultural connectedness may be an effective approach to obesity prevention in tribal communities, although future research would be needed to assess the impact of the intervention on obesity rates.
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Affiliation(s)
- Katie Cueva
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK.
| | - Kristen Speakman
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Nicole Neault
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Jennifer Richards
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Ventura Lovato
- Native American Community Academy Inspired Schools Network
| | - Sean Parker
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | | | - Anna Sundbo
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Allison Barlow
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
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